by Kazeem Olalekan MRPharmS



On Tuesday the 20th of October 2009, the Southampton Branch of the Royal Pharmaceutical Society hosted a presentation by Dr Kieran Hand, Consultant Pharmacist– Anti-infectives at Southampton University Hospitals Trust. It was a remarkably successful evening on a number of fronts and I will highlight these here:


The Speaker


Dr Kieran Hand is a BSc Pharmacy graduate of Strathclyde University and began his career in hospital pharmacy as a resident pharmacist at the Chelsea and Westminster Hospital in London. He earned his PhD in pharmacology from the University of London and continued his research as a postdoctoral fellow before a brief career in the pharmaceutical industry in clinical trials pharmacovigilance. In 2002, Dr Hand returned to Chelsea and Westminster, appointed to a position of specialist microbiology pharmacist, and graduated from the first cohort of the MSc in Infection Management for Pharmacists at Imperial College. In January 2007, Kieran was appointed to the first consultant microbiology/Infectious Diseases pharmacist post in the UK, at Southampton University Hospitals NHS Trust. Kieran led a team in SUHT that won the 2009 UK Clinical Pharmacy Associations (UKCPA) Novatis Award for Antimicrobial Management for the design and implementation of an electronic referral system for microbiology ward rounds. He is a committee member former chair of the UKCPA’s infectious management group and he sits on the Health Protection Agency programme board for healthcare-associated infection and antimicrobial resistance and the antibiotics prescribing sub-committee of the Department of Health Advisory committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI). Dr Hand is a council member of the British Society for Antimicrobial Chemotherapy and an editor at the Journal of Antimicrobial Chemotherapy.


So here we have an eminent speaker and a pioneer pharmacist.



The Audience


The Royal Pharmaceutical Society of Great Britain (RPSGB) has around 130 local branches which provide a local focus for professional and educational matters and hold regular meetings on a wide range of scientific and current affairs topics. Southampton Branch (http://www.rpsgb.org/branches/Southampton/) is a very dynamic branch consisting of pharmacists from community and hospital practises within the area. This meeting was to my knowledge, one of the best attended with over 60 members setting aside their evening to listen to Dr Hand deliver his talk. I guess we all wanted to know what the storm was all about. A cross section of the audience revealed a diverse audience from final year student of pharmacy at the University of Portsmouth and Pre-registration Pharmacy students to Practising Pharmacists (hospital and community) and Pharmacy Technicians.


The Presentation


The first thing that was remarkable about the presentation was its sheer comprehensiveness. There was something in it for the Final year Pharmacy students, something in it for the pre-registration pharmacist and certainly a lot in it for the hospital and community pharmacists. There were practical tips which pharmacy technicians found very interesting. On a personal note, I needed this presentation to help dust down my knowledge of infectious disease and management. So Dr Hand kindly made his presentation available to attendees and we have a copy on our server for registered users of our service to view. Just click here. Otherwise contact Katerina Mesmer (kat@bookapharmacist.com) for a copy of the presentation.


The storm gathering


The metaphor of antibiotic resistance being a perfect storm is apt. Dr Hand described a declining trend in number of antibacterial agent approval over the last 25 years. From 16 in 1983-1987 to just 4 in 2003-2007. He showed a powerful slide which illustrated the declining number of new antibiotic classes. The Oxazolidinones being the only new class of antibiotics from 2000 onwards.


An important element of this gathering storm is the proportional correlation between the amount of antibiotics prescribed and antibiotic resistance. Kieran explained why this might be the case using a powerful illustration. He used the opportunity refresh our minds on mechanism of actions of some antimicrobials and their spectrum of activity. The colourful slides are a God-send and will act as a good quick reference source.


Now we know, the question is how do we deal with this gathering storm? Dr Hand’s presentation was explicit. He drew on some of the work he did on Clostridium difficile infections (CDI) at Southampton University Hospital Trust(SUHT). The modifiable risk factors were: (1) Reduce contact with spores and (2) Reduce high-risk antibiotic exposure. The graphs he displayed have started to show a reduction in the cases of CDI at SUHT after the interventions.


Another factor that made this presentation unique is the fact that Dr Hand drew on the work done by Professor Paul Little of the University of Southampton in Primary Healthcare. You can hear professor Little on the BBC Today program in July 2008 describing some of his findings (here). Community pharmacists have an important role to play in modifying that cycle of expectation which Professor Little described.


The result of the Community-acquired pneumonia epidemiology study by Patrick Charles and others in Australia illustrates the ongoing battle of ideologies over broad-spectrum or narrow-spectrum antibiotic therapy. Matthew Drydon, Kieran Hand and Peter Davey concluded that “narrow-spectrum agents are often as effective and result in less collateral damage” (Antibiotics for community-acquired pneumonia – Journal of Antimicrobial Chemotherapy doi:10.1093/jac/dkp359).


So there you have it: We have a gathering storm and we can still do things to mitigate the problem. The overriding messages are: adopt ‘clean’ strategies, delay use of antibiotics in certain primary care situations and use the right medicines for the infection. It is on the back of this that the Hampshire and Isle of Wight developed a Guideline for Antibiotics Prescribing in the Community in 2008. We have a copy for our members to view here. It is now widely used across the area. Many thanks to the Medicines Management Teams, Professor Little and Dr Hand for all their efforts in making this guideline a reality.


Sponsors


This meeting was sponsored by unconditional grant from Pfizer and bookapharmacist.com (that is us!). We hope Pfizer will continue to work intently on antimicrobials in order that we may have new agents to help fight the increasingly resistant microbial infections. Many thanks to Pfizer for the support. As far as we are concerned, we will continue to work to support the efforts of the Branch in particular and the changes in Pharmacy, in general. Today we support a Branch meeting. Tomorrow who knows?


We will continue to work to bring valuable information and support to our members. If you are not yet a member or haven’t yet felt an interest in joining, we hope you will read more about the project here. We will be waiting to welcome you into our fold.


Many thanks

Tonight bookapharmacist.com in conjuction with Pfizer, are supporting an important Branch meeting on Antibiotics Resistance (-Just another example of big Pharma working with Pharmacists). Download the events pdf here. The talk on Antibiotic Resistance will be given by no other than Dr Kieran Hand, Consultant Pharmacist – Anti-infectives at Southampton University Hospitals Trust. This promises to be a great talk and the attendee should really get a great deal out of the day.


Antibiotic pharmacists in the ascendancy – Dr Kieran Hand – Journal of Antimicrobial Chemotherapy (Link). Dr Hand has also done a lot of work around the Antibiotic risks for Clostridium Difficile.


We will be keen to understand how community pharmacists can play important roles in averting the devastating consequence of perfect storm that is antibiotics resistance.

We were at the Chemist and Druggist (C&D) conference held at the NEC in Birmingham on the 11th of October 2009 and we loved it. We recommend that you attend next year’s event. We definitely switched onto the topical discussions. The big picture is becoming even clearer!


The presentations by Sue Sharp (PSNC Chief Executive) and Jonathan Mason (NHS Clinical Director of Pharmacy) were very interesting. When Steve Poulton of Pfizer talked about how big Pharma can work in collaboration with Pharmacy, it was music to our ears. We didn’t realise Pfizer was formed from the collaboration between a Chemist and a Confectioner! How interesting. When Professor Joy Wingfield took to the stage, the whole hall was packed! Well, that is what Responsible Pharmacy regulation does to you!

Shame we couldn’t attend day 2 of the conference. But from what we saw, we will be attending next year…all of it! We hope you would too.


Follow Chemist and Druggist on Twitter: http://twitter.com/ChemistDruggist or just go to their website: http://www.chemistanddruggist.co.uk: They do pack it with useful pharmacy information. And Jonathan Mason hosts his blog there too. Check it out: http://www.chemistanddruggist.co.uk/mason

We hate to be picky here but this issue of extra packaging layer is our bugbear just now. We have now catalogued three cases (including this one). Maybe if we continue to do this, someone will take note and come up with a wonderful idea to minimise packaging. We all have to do our bit don’t we…for the sake of the planet!



http://www.bookapharmacist.com/?tag=packaging

At bookapharmacist.com we like to recognise a good level of preparedness of the IT tools we have to work with in community pharmacy. This case echoes the point that was made by MUROnline in relation to the proposed unified MUR interface (UMI): “The pace of implementation of software changes is determined by the speed of the system provider to respond to change not by the need of the pharmacist or the pharmacy business” (1).

The Responsible Pharmacy(RP) regulation came to effect on the 1st of October 2008 (Thursday). The IT system I use was obviously not geared for the change yet. However, I worked in a different shop on the Saturday the 3rd of October and was pleasantly surprised that the IT system there was geared for the RP regulation (screenshot below).



This system can print out your legal notifications as well as make the necessary logs. A number of providers have produced commercial software to make pharmacies compliant with the regulation.

bookapharmacist.com is currently planning a response to the regulation but before we do, we would like to say a big well done to Rx Systems Ltd (Email: info@rxsystems.co.uk; Sales/Support: 0845 634 2634) (and some of the other systems providers) for being getting there first.

References
(1) http://sysmur.blogspot.com/2009/05/about-umi.html

http://www.youtube.com/watch?v=H4UTmU04cQ8
Department of Health | 2008

Here, we follow up on our post of the 15th of September 2009 titled: New Packaging: What is the point? Here is another evidence of increasing use of extra layer of packaging for medicinal products. Anyone with ingenious ways of tackling this increasing problem?

It is difficult not to have noticed the oncoming significant change in community pharmacy regulation. We are referring to the Responsible Pharmacist regulation which is due to take effect in eh…3 days (1st October 2009). At bookapharmacist.com, we call it “the birth of responsibility”. If this is the birth of responsibility, then what has community pharmacy (and pharmacists) been doing for the past decade or more? We guessed that question may have crossed your mind. We discussed our response to the Responsible Pharmacist regulation at one of our group meeting held on the 18th of September 2009 (link).


How we approached the issue:


Armed with the Responsible Pharmacist Toolkit – Link (pictured), we got to work. At the end of our deliberations, we resolved that:


1. Before and after the introduction of the Responsible Pharmacist regulation, the community pharmacists will continue to make important contributions to the welfare of their patients in the community. They have been and will continue to be responsible practitioners.

2. The way we practice is changing and we are now being required to do more. We now deliver Medicines Use Reviews, we now work as integral members of the multidisciplinary healthcare workforce, we now visit patients at home to deliver pharmaceutical care to those who cannot visit us in the pharmacy. We also envisage our roles to expand in the future. Some of these roles will inevitably take us away from the pharmacy for short periods of time.

3. We judged that the Responsible Pharmacist regulation is designed to allow us to change with our changing role without compromising the important job we are already doing.

4. It is also an opportunity re-emphasise and recalibrate our roles and responsibility as community pharmacists.

5. The critical changes relates to the ability for the responsible pharmacist to be absent for up to 2 hours per day from the pharmacy.

6. The process changes relates to the display of personalised responsible pharmacist and staff notices plus the pharmacy to keep a record sheet.

7. We also resolved that bookapharmacist.com, will provide a range of support for our pharmacists to enable them discharge the Responsible Pharmacist duties effectively. If you are one of our pharmacists, please watch a presentation on how we are supporting you to discharge your responsibility(Video to follow later).


The RPSGB has issued a new guidance which clearly sets out a list of key relevant activities and clarifies whether they:

1. Require a responsible pharmacist to be in charge of the premises (s/he may be absent for up to two hours per day) and will need to take place under the supervision of a pharmacist and who will need to be present at the premises;

2. Require a responsible pharmacist to be in charge of the premises (s/he may be absent for up to two hours per day) and take place under the supervision of a pharmacist who may not need to be physically present at the premises;

3. Require a responsible pharmacist to be in charge of the premises (s/he may be absent for up to two hours) but does not require the supervision of a pharmacist;

4. Do not require a responsible pharmacist to be in charge of the premises but does require the pharmacy support staff undertaking the activity to be appropriately trained and for the activity to be done under standard operating procedures.

You can access the guideline here: http://www.rpsgb.org/pdfs/rprequirementsguid.pdf

Chemist and Druggist also provided a useful information about responsible pharmacists here (including the 10-part countdown): http://www.chemistanddruggist.co.uk/responsiblepharmacist/

Of course the responsible pharmacist regulation is not limited to community pharmacists. The RPSGB has produced a guideline for Hospital Pharmacists in association with the Pharmaceutical Society of Northern Ireland: http://www.rpsgb.org/pdfs/rprequirementshospguid.pdf

A note for the diary:

The president of the RPSGB, Steve Churton, will be speaking at the Hampshire and Isle of Wight LPC AGM on the 30th of September 2009 about the Responsible Pharmacy regulation. We will be there and we hope you can make it. Book your place: http://hampshirelpc.org.uk/index.asp?type=event&id=507



We will continue to work to bring valuable information and support to our members. If you are not yet a member or haven’t yet felt an interest in joining, we hope you will read more about the project here. We will be waiting to welcome you into our fold.


Thanks for now and have a great week.


Administrator
bookapharmacist.com


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by Kazeem Olalekan MRPharmS MBCS

References:

MHRA has just posted this Drug Safety Information with respect to Phenergan Elixir PL 04425/0630, 100ml packs. The labelling may “cause confusion to diabetic patients”. This relates to the technical distinction between hydrogenated glucose (which is not considered as sugar and therefore does not carry the risks of dental caries but nonetheless not suitable for diabetics) and others such as sucrose, glucose or fructose (which are classified as sugars, which can cause dental caries and also unsuitable for diabetics).


The statement ‘sugar-free’ is printed on the front panel and one side panel of the carton and the warning ‘not suitable for diabetics’ is printed on the other side panel of the carton.


For more information, please visit the MHRA site: http://www.mhra.gov.uk/Publications/Safetywarnings/DrugAlerts/CON057396